Content

“All you need is sleep”

Summary

Insomnia is a serious sleep disorder which is frequently undiagnosed or untreated. Treatment options for those who seek help, however, are not clearly defined. The community of health care providers must communicate more effectively amongst each other to strike a balance between pharmacological interventions and the benefits of non-pharmacological treatments such as CBT-I.

One of the most underdiagnosed health conditions, insomnia is a serious sleep disorder which continues to plague millions of people in the US and worldwide. Insomnia has significant negative effects on physical and psychological health, work productivity, and general well-being. Research shows that many people suffering from insomnia avoid seeking care through conventional channels such as their primary care physicians, behavioral therapists, or sleep medicine specialists. Internet resources appear to be the preferred channel most people use to obtain relevant information regarding insomnia. However, is the internet a reliable source of information concerning insomnia, and is there a consensus among health care providers on best practices to treat insomnia?

“A culture of quick fix” is a major impediment to educating and motivating patients to try therapies that do not involve medications, says Dr. Meredith Cary, a health psychologist in Washington, D.C. who treats many patients with insomnia using Cognitive Behavioral Therapy for Insomnia (CBT-I) approach. CBT-I is a proven therapy for helping patients overcome insomnia that employs behavioral, educational and cognitive techniques. The American Academy of Sleep Medicine, the American Academy of Family Practitioners, and the American College of Physicians all recommend CBT-I as the first-line of treatment for insomnia. Although CBT-I is recognized to work with 80% efficacy to treat chronic insomnia, it is unclear whether medical providers see it as such. Since they are not themselves trained in offering CBT-I as treatment, referrals to appropriate behavioral specialists are needed but are often not the first order of business for many physicians. Many medical providers see no harm in short-term pharmacological interventions to aide with sleep. However, the medications that are often prescribed for insomnia are not meant for long-term use, are often ineffective and must be periodically switched to avoid drug dependency.

For Rose, one of Dr. Cary’s former patients, it took almost 15 years of trying ineffective drug therapies to treat her insomnia until she finally tried CBT-I to address her sleep disorder. Rose’s insomnia, which was treated for years with medications such as Ambien and Klonopin, was getting progressively worse. “The treatment over the years was really just ‘putting out fires,” says Rose. “CBT-I was so dramatically different from anything I’d done. The underlying frustration about insomnia is that in some ways there’s really nothing to talk about. With CBT-I it was like let’s not talk about it, let’s just do it. It was really liberating….”

Additional barriers for consumers in getting CBT-I help with insomnia is the cost of such behavioral therapy treatment when not covered by insurance. The Internet offers a promising avenue to address the expense challenge. Several online programs exist, such as Sleepio and SHUTi, which utilize the CBT-I approach for treating insomnia without the need for a behavioral specialist’s involvement. Research shows that such online applications can significantly improve sleep outcome for even those with severe insomnia.

To help people suffering from insomnia avoid dangerous and ineffective drug therapies and to access CBT-I, medical providers need to lay out clear treatment choices for patients from the start. Dr. Cary and her colleagues are establishing an online Insomnia Hub to improve access to information about insomnia treatments by enabling a community of consumers, providers and educators to share their knowledge about this debilitating sleep disorder.

Better communication about best treatments can help reduce suffering and provide permanent and effective relief from insomnia.